Infectious diseases acquired by international travellers visiting the USA.
Stoney RJ., Esposito DH., Kozarsky P., Hamer DH., Grobusch MP., Gkrania-Klotsas E., Libman M., Gautret P., Lim PL., Leder K., Schwartz E., Sotir MJ., Licitra C., GeoSentinel Surveillance Network None., Yansouni C., Thomas A., Sonnenburg FV., Rothe C., Kain K., Boggild A., Cahill J., McKinley G., Yoshimura Y., Tachikawa N., Javelle E., Borwein S., Caumes E., Perignon A., Mockenhaupt F., Harms-Zwigenberger G., Kanagawa S., Kato Y., Schlagenhauf P., Weber R., Plewes K., Ghesquire W., Mirzanejad Y., Jordan S., Vinnemeier C., Mendelson M., Parker S., McCarthy A., Vincelette J., Barkati S., Asgeirsson H., Glans H., Castelli F., Matteelli A., Kuhn S., Warne B., Torresi J., Connor B., Jensenius M., Genderen PV., Kelly P., Rapp C., Ficko C., Perret-Perez C., Siu H., Valdez LM., Goorhuis A., Chappuis F., Hoang Phu PT., Pandey P., Murphy H., Shaw M., Lopez-Velez R., Norman F., Piyaphanee W., Silachamroon U., Haulman J., Terry A., Larsen CS., Wejse C., Bottieau E., Clerinx J., Flores-Figueroa J., Lalloo D., Beeching N., Anderson S.
Background:Estimates of travel-related illness have focused predominantly on populations from highly developed countries visiting low- or middle-income countries, yet travel to and within high-income countries is very frequent. Despite being a top international tourist destination, few sources describe the spectrum of infectious diseases acquired among travellers to the USA. Methods:We performed a descriptive analysis summarizing demographic and travel characteristics, and clinical diagnoses among non-US-resident international travellers seen during or after travel to the USA at a GeoSentinel clinic from 1 January 1997 through 31 December 2016. Results:There were 1222 ill non-US-resident travellers with 1393 diagnoses recorded during the 20-year analysis period. Median age was 40 (range 0-86 years); 52% were female. Patients visited from 63 countries and territories, most commonly Canada (31%), Germany (14%), France (9%) and Japan (7%). Travellers presented with a range of illnesses; skin and soft tissue infections of unspecified aetiology were the most frequently reported during travel (29 diagnoses, 14% of during-travel diagnoses); arthropod bite/sting was the most frequently reported after travel (173 diagnoses, 15% after-travel diagnoses). Lyme disease was the most frequently reported arthropod-borne disease after travel (42, 4%). Nonspecific respiratory, gastrointestinal and systemic infections were also among the most frequently reported diagnoses overall. Low-frequency illnesses (<2% of cases) made up over half of diagnoses during travel and 41% of diagnoses after travel, including 13 cases of coccidioidomycosis and mosquito-borne infections like West Nile, dengue and Zika virus diseases. Conclusions:International travellers to the USA acquired a diverse array of mostly cosmopolitan infectious diseases, including nonspecific respiratory, gastrointestinal, dermatologic and systemic infections comparable to what has been reported among travellers to low- and middle-income countries. Clinicians should consider the specific health risks when preparing visitors to the USA and when evaluating and treating those who become ill.